Depression and Troubled Sleep

Colette Dowling, LCSW

Author of the following article on couples counseling and real love, NYC psychotherapist Colette Dowling, LCSW, has also written The Cinderella Complex: Women's Hidden Fear of Independence, a best seller in twenty-three languages, and other books on relationhip issues.

What To Do for Troubled Sleep

People suffering from depression and troubled
sleep approach bedtime with varying degrees of dread. They toss
and turn, restlessly occupied with negative thoughts, obsessing over
something dumb they did, or think they did, at the party that night.
Money, taxes, their teeth falling out of their gums, you name it they
have fantasies about it.

When I became depressed after a long bout of anemia, it reached a
point where I was worrying about my writing studio tumbling into the
stream next to it. It wasn’t a rational worry, I knew, but I felt helpless to
control what my mind was doing. Depression was producing troubled sleep.

Anyone who’s been depressed knows how it goes. A relentlessly
disturbing train of thought can begin with just the tiniest kernel of
reality. For example, the bank along the stream next to my writing
studio was etched away in places, damaged by heavy spring rains. this
erosion escalated in my mind as depression began to take hold. First, I
worried about losing my studio. Then I worried about losing my house,
which was on the same piece of land. Depression and troubled sleep.
There it was! But I didn't know it, at the time. All I was consumed
with were my feverish, night-time thoughts. Maybe I should sell the
property before my entire nest egg was swept away by the ravages of
nature. On the other hand, the real estate market was so bad, maybe
there would be no nest egg, And so on and so on.

Lying in bed at night provides prime time for obsessonal
thinking. Lucky were the mornings when sanity returned and I could tell
myself, as the sun began peeping through the blinds, "This house has
been sitting here since 1775; I don’t think it’s going anywhere soon."

The biological underpinnings of these anxious thoughts became
strikingly clear when, after taking iron for a month or so for the
anemia, my blood count returned to normal and so did my mood.
Suddenly–-really, from one week to the next–-concerns about the imminent
demise of my house and studio vanished. My daytime thoughts became
positive, and my nighttime thoughts returned to dreamland, where they
belonged.

Trouble falling asleep is usually associated with anxiety. On the
other hand, regularly waking at four o’clock in the morning is
considered a sign of depression. In milder cases only an hour or so of
sleep may be lost. When depression is more serious, the loss can add up
to several hours or more a night. Some people say they don’t get any
sleep at all, or they fall asleep shortly before they’re supposed to get
up.

Those in their sixties, seventies and eighties who have trouble
sleeping should be evaluated for depression, if no organic reason for
sleep loss can be found. Some physicians think poor sleep is inevitable
in older patients. It isn’t, and it should be taken seriously.
Depression and troubled sleep appears in the elderly with as much
frequency as it does in younger folks.

Lack of rest is not the only sleep disturbance associated with
depression. Someone who’s going to bed at midnight and getting up at one
the next afternoon also has a sleep problem. Hypersomnia, it’s
called–-the need for more sleep than normal.

No matter which kind of sleep disturbance, it will become more
severe as the depressive episode gathers force. There may be terrible,
depressive dreams and then waking from these dreams abruptly, sometimes
in sobs. Of course the sleep people lose when they're depressed produces
fatigue during the day and this can wreak havoc on the job.

Improved sleep, on the other hand, can be the first sign that a
depression is lifting. This is especially noticeable in the patient
who's been treated with antidepressants. Long before her mood improves
she'll fall asleep more easily and find herself able to sleep through
the night. Appetite–-whether minimal or excessive--will begin to
normalize. Weight loss-–or gain-–will stop. Before long, things start
looking positive again.

When episodes of depression are severe, psychotherapy plus
medication is usually the most effective course of action. Serotonin
reuptake inhibitors (SSRIs) such as Zoloft, Effexor, and Prozac often
begin showing effectiveness within a couple of weeks. That the
antidepressant has begun working will first be noted in improved quality
of sleep.

Mindfulness skillsare also helpful in improving depression and troubled sleep. In my practice I teach different types of breathing. I also use audio equipment in a technique that helps people slow down their thought processes so that they can integrate things that have happened to them in the past with new thoughts, allowing relief from anxiety or trauma.

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About the Author

NY psychotherapist Colette Dowling, LCSW, received her masters
degree from The Smith College School for Social Work and has done
advanced training in psychotherapy and psychoanalysis at The Institute for Contemporary Psychotherapy, in
New York. She has a private practice in Manhattan.

For more information, or to arrange a consultation,
call 718-594-0201, or e-mail dowlingcolette@earthlink.net

To hear Colette speaking about what it's like starting therapy with someone new, click the audio button.